Light R W
Pulmonary Diseases, Saint Thomas Hospital, Vanderbilt University, Nashville, Tennessee, USA.
Curr Opin Pulm Med. 2001 Jul;7(4):198-201. doi: 10.1097/00063198-200107000-00006.
Pulmonary embolism is the fourth leading cause of pleural effusion. The possibility of pulmonary embolus should be evaluated for all patients who have undiagnosed pleural effusion. The mechanism of pleural effusion caused by pulmonary embolus is usually increased interstitial fluid in the lungs as a result of ischemia or the release of vasoactive cytokines. Approximately 75% of patients with pulmonary emboli and pleural effusion have pleuritic chest pain. The most common cause of pleuritic chest pain and pleural effusion in patients under 40 years old is pulmonary emboli. Pleural effusion resulting from a pulmonary embolus usually occupies less than one-third of the hemithorax. Dyspnea is frequently out of proportion to the size of the pleural effusion. Pleural fluid caused by pulmonary emboli is usually exudative but is occasionally transudative. d-Dimer testing is a good screen for pulmonary emboli. If d-dimer results are positive, then a spiral computed tomograph should be obtained to confirm the diagnosis. Low-molecular-weight-heparin has become the initial treatment of choice for patients with pulmonary emboli and pleural effusion.
肺栓塞是胸腔积液的第四大常见病因。对于所有胸腔积液病因未明的患者，均应评估其发生肺栓塞的可能性。肺栓塞导致胸腔积液的机制通常是由于局部缺血或血管活性细胞因子释放，致使肺间质液增加。约75%的肺栓塞合并胸腔积液患者有胸膜炎性胸痛。40岁以下患者发生胸膜炎性胸痛和胸腔积液的最常见原因是肺栓塞。肺栓塞所致胸腔积液通常占据不到半侧胸腔的三分之一。呼吸困难的严重程度常常与胸腔积液量不成比例。肺栓塞引起的胸腔积液通常为渗出液，但偶尔也可为漏出液。D -二聚体检测是筛查肺栓塞的有效方法。如果D -二聚体检测结果呈阳性，则应进行螺旋计算机断层扫描以确诊。低分子量肝素已成为肺栓塞合并胸腔积液患者的首选初始治疗药物。
